Replies to This Discussion

Permalink Reply by Jenny on May 2, 2009 at 2:12pm

That looks VERY conclusive to me. Most Type 2s I know even those using insulin still test into the normal range, fasting.

Yours is low enough, you should be evaluated for LADA.

I'm probably MODY and my fasting C-peptide was right smack in the middle of normal. That's what would be expected.

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Permalink Reply by Zoe on May 2, 2009 at 2:23pm

Thanks, Jenny. I have an endo appointment next Wednesday because I have been thinking more and more I was mis-diagnosed as Type 2.

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Permalink Reply by Duncan on May 7, 2009 at 7:17am

My c-peptide initially was 2.5 on a 1.1-5.0 scale. 18 months later it was 1.1 non fasting and 0.8 fasting. Both times I was negative for insulin antibodies. I'm going to ask about a re-test for antibodies next appointment since it's been about 9 months. I've decided that it doesn't really matter what type I am as long as the treatment is working and will work long term, and I think I've finally found it. I consider myself type 2 though.

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Permalink Reply by Candi on June 5, 2009 at 3:03am

My fasting c-peptide is 1.9 at diagnosis. My GAD was 10. I am diagnosed as a Type 1 at 35 years of age. I hope this helps some.

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Permalink Reply by Zoe on June 5, 2009 at 6:23am

Thanks, Candi. Since I posted this thread my endo has diagnosed me as Type 1. Technically I'm 1.5 but that diagnosis isn't official yet so she didn't use it.

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Permalink Reply by Melitta on June 6, 2009 at 9:48am

Hi Zoe: Good for you for pursuing this. FYI, medically, a person is not diagnosed as having Type 1.5. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus does not recognize LADA/1.5, the Expert Committee includes those in the Type 1 category. So your doctor is correct to diagnose you as Type 1, not 1.5.

Also, you bring up a common myth regarding Type 2 in your first post, which is that in Type 2 insulin production by the beta cells declines over time. This is not true, according to "Latent Autoimmune Diabetes in Adults: Definition, Prevalence, Beta Cell Function and Treatment" in Diabetes Vol. 54, Supplement 2, December 2005. In that article, the authors point out that if you remove people with autoimmune markers for Type 1a diabetes (aka slow onset Type 1 diabetes in adults almost always misdiagnosed as Type 2) from studies of Type 2 diabetics, "beta cell function was unaffected and preserved 12 years after diagnosis among individuals without islet antibodies." If patients with LADA/Type 1.5 are appropriately removed from studies looking at beta cell function in Type 2 diabetics, there is no decline in production of insulin in the true Type 2 diabetics.

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Permalink Reply by Zoe on June 6, 2009 at 10:02am

I definitely appreciate your level of research, Melitta! I do respectfully disagree with the correctness of diagnosing Type 1, rather than Type 1.5. I think the ADA, The Expert Committee el al are extremely behind the facts in their lack of willingness to diagnosis LADA. Using Insulin by John Walsh was printed in 2003 (which means it was probably researched a in 2001-8 years ago) and clearly lays out the LADA distinction. I believe the reasons why the "powers that be" are so far behind in their approval of LADA. In the U.S. especially, is that much hinges on managed care, which means that doctors are rigidly bound to the established protocols even when their instincts and experience tell them otherwise. They are also afraid of getting "stuck for the bill" if they do a non-approved treatment or test. Insurance, not medical practice dictates care and this imho is very wrong. Likewise the fear of malpractice and exhorbitant premiums going even higher is a motivator for caution. Perhaps we are talking semantics here, and you are correctly telling me "how it is" , but I am more concerned with "how it should be". I also have heard on here and elsewhere of diabetics whose endos or even PCPs were willing to buck those tides and correctly diagnose LADA and I say more power to them.If doctors continue to adhere rigidly to the Type 1/Type 2 dichotomy they will continue to ignore that significant 15-20% of people who appear to be Type 2 but are in fact Type 1.5
Ok, stepping down off my soapbox.

If there is no decline in production of insulin in the true Type 2 diabetic, than why over time (average 10+ years) does it become necessary for Type 2's to go to insulin use?

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Permalink Reply by Melitta on June 7, 2009 at 5:49pm

Hi Zoe: I completely understand why you would disagree with what I said. We both want to see more recognition of LADA/Type 1.5/adult onset Type 1. So many of us are misdiagnosed as having Type 2 diabetes, a different disease altogether, and that is a travesty. My focus has been trying to push the medical/diabetes community to recognize that adult onset Type 1 is two to three times more common than childhood onset Type 1 (always has been, I have a book from the 1950's that states that). Because in fact they are all autoimmune diabetes, so all the same disease. That is why I don't see a need for LADA/1.5 versus 1. But I completely understand your point. I don't actually fit the criteria for LADA--I had rapid onset (hospitalized in DKA) Type 1 at age 35, but yet I was still misdiagnosed as having Type 2.

I do disagree with your comments about "fear of malpractice." If doctors truly had a fear of malpractice, they would do all the right tests (antibody testing, c-peptide). I am very surprised that no one yet (that I am aware of) has filed a medical malpractice claim when misdiagnosed as having Type 2, when in fact they have Type 1. The diagnostic tools are readily available (at least in the U.S.) to provide a correct diagnosis.

As for why it becomes necessary for Type 2s to go on insulin, I don't know. I just study Type 1, with an emphasis on adult onset Type 1. Type 2 diabetes is certainly complicated, but it is a disease I don't have so I haven't focused on it. The article about no decline in insulin production in Type 2s (when you remove those pesky LADAs from the statistical pool) was an article about LADA.

Good for you for pursuing good care for yourself. We all have to be our own best advocates.

Melitta

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Permalink Reply by Zoe on June 7, 2009 at 8:24pm

Sounds like we are just coming at similar ideas from a bit different perspective.

I believe I've read the LADA article you reference. I think it may be just referencing the much longer time it takes for insulin production to lessen in Type 2's, not saying it never does.

As for suing the docs for misdiagnosis, unfortunately I think that won't happen until something awful happens to someone because they were misdiagnosed.

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Permalink Reply by Tiffany Rodriguez on June 29, 2009 at 10:54am

i havent read the other replies yet to this,,, but i believe the reason that some type 2s over time need insulin is because they end up so resistant to their own, that they need even more then what their body can produce, this is also why so many type 2s use way over 5 times the insulin a type 1 needs when first started on insulin On average a total starting insulin dosing is 70 plus units a day for type 2, and 35 units average for type 1s

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Permalink Reply by Zoe on June 29, 2009 at 11:24am

The reasons Type 2's over time need insulin is because their body produces less and less and so they start to become insulin deficient (like Type 1's) in addition to their problem with insulin resistance.

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Permalink Reply by Tiffany Rodriguez on June 29, 2009 at 11:35am

when your body produces less and less insulin, thats type 1. all true Type 2 wouldnt be called type 2 if you were like a type 1 in the end. I know 8 type 2s and all of them still make high levels of insulin but cant use it right, and 2 are on insulin after 10+ years and they still have high c peptides. Type 1s can develop insulin resistance, but type 2s generally dont lose insulin their body just cant keep up with the amount they need to control their blood sugar, whether because of weight, diet, or little to no exercise

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